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Lamadrid A, Jeffery C, Anguyo R, Devkota B, Lako R, Valadez JJ. Assessing attitudes towards violence against women and girls, their determinants and health-seeking behaviour among women and men in South Sudan: a cross-sectional national survey. BMJ Open 2024; 14:e080022. [PMID: 38834318 PMCID: PMC11163628 DOI: 10.1136/bmjopen-2023-080022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 05/04/2024] [Indexed: 06/06/2024] Open
Abstract
OBJECTIVE Investigating attitudes accepting two categories of violence against women and girls (VAWG) (intimate partner violence-IPV-and other expressions of VAWG) and their association with seven demographic/social determinants and health-seeking behaviours in South Sudan. DESIGN Cross-sectional study using data from the South Sudan National Household Survey 2020. SETTING South Sudan. PARTICIPANTS AND METHODS 1741 South Sudanese women and 1739 men aged 15-49 years; data captured between November 2020 and February 2021 and analysed using binary logistic regression. RESULTS People with secondary or higher education displayed attitudes rejecting acceptance of IPV (OR 0.631, 95% CI 0.508 to 0.783). Women and men living in states with more numerous internally displaced people (IDP) or political/military violence had attitudes accepting IPV more than residents of less violence-affected regions (OR 1.853, 95% CI 1.587 to 2.164). Women had a higher odd of having attitudes accepting IPV than men (OR 1.195, 95% CI 1.014 to 1.409). People knowing where to receive gender-based violence healthcare and psychological support (OR 0.703, 95% CI 0.596 to 0.830) and with primary (OR 0.613, 95% CI 0.515 to 0.729), secondary or higher education (OR 0.596, 95% CI 0.481 to 0.740) displayed attitudes rejecting acceptance of other expressions of VAWG. People residing in states with proportionately more IDP and who accepted IPV were more likely to have attitudes accepting other expressions of VAWG (OR 1.699, 95% CI 1.459 to 1.978; OR 3.195, 95% CI 2.703 to 3.775, respectively). CONCLUSION Attitudes towards accepting VAWG in South Sudan are associated with women's and men's education, gender, residence and knowledge about health-seeking behaviour. Prioritising women's empowerment and gender transformative programming in the most conflict-affected areas where rates of VAWG are higher should be prioritised along with increasing girls' access to education. A less feasible strategy to decrease gender inequalities is reducing insecurity, military conflict, and displacement, and increasing economic stability.
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Affiliation(s)
- Angelo Lamadrid
- International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Caroline Jeffery
- Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, UK
| | - Robert Anguyo
- International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Baburam Devkota
- International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Richard Lako
- Former Director Division of Research, Monitoring and Evaluation, Government of the Republic of South Sudan Ministry of Health, Juba, South Sudan
| | - Joseph J Valadez
- International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
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Kidman R, Breton E, Behrman JR, Zulu A, Kohler HP. Longitudinal Associations Between Childhood Adversity and Adolescent Intimate Partner Violence in Malawi. JOURNAL OF INTERPERSONAL VIOLENCE 2023; 38:7335-7354. [PMID: 36695114 DOI: 10.1177/08862605221145720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Adverse childhood experiences (ACEs)-including child maltreatment, witnessing violence, and household dysfunction-have been robustly associated with poor health in later life. There is also increasing evidence that those who experience childhood adversity are more likely subsequently to be victims or perpetrators of intimate partner violence (IPV). Most evidence, however, is cross-sectional and concentrated in high-income settings, and cannot be generalized to more diverse contexts. In contrast, this study assessed longitudinal relations between ACEs and IPV in a low-income country. We interviewed 1,878 adolescents in rural Malawi between 2017 and 2018 (aged 10-16) and again in 2021 (aged 13-20). Adolescents completed the Adverse Childhood Experience-International Questionnaire. Past-year physical, sexual, and emotional IPV victimization and perpetration were measured using the WHO's Violence Against Women Instrument. We estimated multivariate regression models between cumulative adversity (0-13 adversities) at baseline and IPV at follow-up among respondents who reported any romantic or sexual partnerships. The cumulative ACEs score was associated with emotional IPV victimization for boys (OR = 1.12 per ACE) and sexual IPV victimization for girls (OR = 1.18). The ACEs score demonstrated a significant association with perpetration for girls only (OR = 1.33 for emotional IPV). By using longitudinal data, we more rigorously demonstrated the critical role of childhood adversity in shaping later IPV behavior. There are ongoing efforts toward primary prevention of childhood adversity. Given the burden that adolescents already carry (six ACEs on average in our sample), we also need secondary interventions that can help interrupt the pathway from adversity to IPV. This calls for increased collaboration between those working to address violence against children and violence against women.
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Affiliation(s)
- Rachel Kidman
- Stony Brook University (State University of New York), USA
| | | | | | - Andrew Zulu
- Invest in Knowledge Initiative, Zomba, Malawi
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3
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Velloza J, Davies LD, Ensminger AL, Theofelus FM, Andjamba H, Kamuingona R, Masseti G, Coomer R, Forster N, O’Malley G. Cycles of Violence Among Young Women in Namibia: Exploring the Links Between Childhood Violence and Adult Intimate Partner Violence From the Violence Against Children and Youth Survey. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP22992-NP23014. [PMID: 35156448 PMCID: PMC9661872 DOI: 10.1177/08862605211073107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Background: Violence against children is a global public health crisis and is associated with poor mental and physical health outcomes. Childhood violence may also increase the risk of subsequent violence revictimization by an intimate partner. We aimed to understand cycles of violence among adolescent girls and young women in Namibia to inform violence prevention and treatment interventions. Methods: The 2019 Namibia Violence Against Children and Youth Survey (VACS) examined the prevalence of childhood violence and intimate partner violence among 18-24 year old adolescent girls and young women (N = 2434). Using the data, we assessed the prevalence of childhood violence, defined as any physical, sexual, or emotional violence victimization prior to age 18, and estimated the prevalence of intimate partner violence (IPV) after age 18. We used a weighted logistic regression to assess whether childhood violence exposure was associated with subsequent experience of IPV after age 18. Results: Adolescent girls and young women in Namibia had a statistically significant higher odds of experiencing IPV if they had experienced any childhood violence including physical, sexual, and/or emotional violence (adjusted odds ratio [aOR]: 2.93; 95% Confidence Interval [95% CI: 1.64-5.23). IPV was also significantly associated with childhood physical (aOR: 1.81; 95% CI: 1.07-3.05), sexual (aOR: 3.79; 95% CI: 2.54-5.67), or emotional (aOR: 2.39; 95% CI: 1.18-4.86) violence when each were considered separately. We also observed a dose-response relationship between the number of types of childhood violence and IPV experience as a young adult. Conclusions: Childhood violence is a significant predictor of subsequent violence revictimization by an intimate partner. This analysis provides unique insights on cycles of violence among adolescent girls and young women in Namibia and points to the need for interventions during childhood to prevent violence against children and break this cycle among young women in sub-Saharan Africa.
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Affiliation(s)
- Jennifer Velloza
- University of Washington, Department of Global Health, Seattle, WA, USA
| | - Luke D. Davies
- University of Washington, Department of Global Health, Seattle, WA, USA
- International Training and Education Center for Health (I-TECH), University of Washington, Seattle, WA, USA
| | - Alison L. Ensminger
- University of Washington, Department of Global Health, Seattle, WA, USA
- International Training and Education Center for Health (I-TECH), University of Washington, Seattle, WA, USA
| | | | - Helena Andjamba
- Ministry of Gender Equality and Child Welfare, Government of Namibia, Windhoek, Namibia
| | - Rahimisa Kamuingona
- Ministry of Gender Equality and Child Welfare, Government of Namibia, Windhoek, Namibia
| | - Greta Masseti
- Division of Violence Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Rachel Coomer
- Centers for Disease Control and Prevention, Windhoek, Namibia
| | - Norbert Forster
- University of Washington, Department of Global Health, Seattle, WA, USA
- International Training and Education Center for Health (I-TECH), University of Washington, Windhoek, Namibia
| | - Gabrielle O’Malley
- University of Washington, Department of Global Health, Seattle, WA, USA
- International Training and Education Center for Health (I-TECH), University of Washington, Seattle, WA, USA
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4
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Christopher E, Drame ND, Leyna GH, Killewo J, Bärnighausen T, Rohr JK. Disclosure of intimate partner violence by men and women in Dar es Salaam, Tanzania. Front Public Health 2022; 10:928469. [PMID: 36225776 PMCID: PMC9549336 DOI: 10.3389/fpubh.2022.928469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 08/15/2022] [Indexed: 01/24/2023] Open
Abstract
Intimate Partner Violence (IPV) has severe health consequences, though may be underreported due to stigma. In Tanzania, estimates of IPV prevalence range from 12 to >60%. List experiments, a technique of indirectly asking survey questions, may allow for more accurate prevalence estimates of sensitive topics. We examined list experiment and direct questions about experiences of physical and sexual IPV from a 2017 cross-sectional survey among 2,299 adults aged 40+ years in Dar es Salaam. List experiment prevalence estimates were determined through quantitative analysis and compared qualitatively to direct question prevalence estimates. The list experiment estimated a higher prevalence of IPV in all cases except for physical violence experienced by women. This study contributes to the estimation of IPV prevalence. If the list experiment estimates yield an unbiased estimate, findings suggest women openly report experiencing physical IPV, and IPV experienced by men is underreported and understudied.
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Affiliation(s)
- Enryka Christopher
- Harvard Center for Population and Development Studies, Harvard T.H. Chan School of Public Health, Cambridge, MA, United States,*Correspondence: Enryka Christopher ;
| | - Ndeye D. Drame
- Harvard Center for Population and Development Studies, Harvard T.H. Chan School of Public Health, Cambridge, MA, United States
| | - Germana H. Leyna
- Department of Epidemiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Japhet Killewo
- Department of Epidemiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Till Bärnighausen
- Heidelberg Institute of Global Health, Faculty of Medicine, University of Heidelberg, Heidelberg, Germany
| | - Julia K. Rohr
- Harvard Center for Population and Development Studies, Harvard T.H. Chan School of Public Health, Cambridge, MA, United States
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5
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Gilbert LK, Annor FB, Kress H. Associations Between Endorsement of Inequitable Gender Norms and Intimate Partner Violence and Sexual Risk Behaviors Among Youth in Nigeria: Violence Against Children Survey, 2014. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP8507-NP8533. [PMID: 33283633 PMCID: PMC8827130 DOI: 10.1177/0886260520978196] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The purpose of this study was to assess whether the endorsement of inequitable gender norms about intimate partner violence against women (IPVAW) and sexual behavior was associated with intimate partner violence (IPV) victimization, IPV perpetration, and sexual risk behavior. Nigerian youth aged 13-24 (n = 4,203) participated in the nationally representative, cross-sectional Nigeria Violence Against Children Survey (VACS) in 2014. Inequitable gender norms about IPVAW were assessed using six items from the Demographic and Health Surveys (DHS), and inequitable gender norms about sexual behavior were assessed using four items adapted from the Gender-Equitable Men (GEM) scale. The number of inequitable gender norms endorsed was summed and associations with having been a victim or perpetrator of IPV and sexual risk behaviors were assessed using logistic regression. Endorsing 3 or more inequitable gender norms about either IPVAW or sexual behavior were both associated with increased odds of IPV victimization, perpetration, and sexual risk behaviors, after adjustment for demographic characteristics, witnessing violence in childhood, and having been a victim of other forms of childhood violence. Demonstrating that endorsement of inequitable gender norms about sexual behavior was associated with violence and that inequitable gender norms about IPVAW were associated with sexual risk behaviors further highlights potential linkages between violence and HIV.
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Affiliation(s)
- Leah K Gilbert
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Francis B Annor
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Howard Kress
- Centers for Disease Control and Prevention, Atlanta, GA, USA
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6
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Mannell J, Lowe H, Brown L, Mukerji R, Devakumar D, Gram L, Jansen HAFM, Minckas N, Osrin D, Prost A, Shannon G, Vyas S. Risk factors for violence against women in high-prevalence settings: a mixed-methods systematic review and meta-synthesis. BMJ Glob Health 2022; 7:bmjgh-2021-007704. [PMID: 35296455 PMCID: PMC8928330 DOI: 10.1136/bmjgh-2021-007704] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 02/08/2022] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Violence against women (VAW) affects one in three women globally. In some countries, women are at much higher risk. We examined risk factors for VAW in countries with the highest 12-month prevalence estimates of intimate partner violence (IPV) to develop understanding of this increased risk. METHODS For this systematic review, we searched PUBMED, CINAHL, PROQUEST (Middle East and North Africa; Latin America and Iberia; East and South Asia), Web of Science, EMBASE and PsycINFO (Ovid) for records published between 1 January 2000 and 1 January 2021 in English, French and Spanish. Included records used quantitative, qualitative, or mixed-methods, reported original data, had VAW as the main outcome, and focused on at least one of 23 countries in the highest quintile of prevalence figures for women's self-reported experiences of physical and/or sexual violence in the past 12 months. We used critical interpretive synthesis to develop a conceptual model for associations between identified risk factors and VAW. RESULTS Our search identified 12 044 records, of which 241 were included for analysis (2 80 360 women, 40 276 men, 274 key informants). Most studies were from Bangladesh (74), Uganda (72) and Tanzania (43). Several quantitative studies explored community-level/region-level socioeconomic status and education as risk factors, but associations with VAW were mixed. Although fewer in number and representing just one country, studies reported more consistent effects for community-level childhood exposure to violence and urban residence. Theoretical explanations for a country's high prevalence point to the importance of exposure to other forms of violence (armed conflict, witnessing parental violence, child abuse) and patriarchal social norms. CONCLUSION Available evidence suggests that heightened prevalence of VAW is not attributable to a single risk factor. Multilayered and area-level risk analyses are needed to ensure funding is appropriately targeted for countries where VAW is most pervasive. PROSPERO REGISTRATION NUMBER The review is registered with PROSPERO (CRD42020190147).
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Affiliation(s)
| | - Hattie Lowe
- Institute for Global Health, UCL, London, UK
| | - Laura Brown
- Institute for Global Health, UCL, London, UK
| | | | | | - Lu Gram
- Institute for Global Health, UCL, London, UK
| | | | | | - David Osrin
- Institute for Global Health, UCL, London, UK
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7
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Ringwald B, Kababu M, Ochieng CB, Taegtmeyer M, Zulaika G, Phillips-Howard PA, Digolo L. Experiences and Perpetration of Recent Intimate Partner Violence Among Women and Men Living in an Informal Settlement in Nairobi, Kenya: A Secondary Data Analysis. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP423-NP448. [PMID: 32370597 DOI: 10.1177/0886260520916268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Evidence suggests an overlap between intimate partner violence (IPV) experience and perpetration. However, few studies in sub-Saharan Africa have investigated experience and perpetration of IPV among women and men within the same community. This study reports prevalence of past-year IPV experience and perpetration among women and men living in an informal settlement in Nairobi, Kenya, and factors associated with IPV. Data analyzed for this study involved a geographically distributed random sample of 273 women and 429 men who participated in a community survey. We approximated prevalence of IPV experience and perpetration and used logistic regression for estimating associations between individual-level factors and IPV. Women and men experienced similar levels of IPV, but a significantly higher proportion of men reported physical and sexual IPV perpetration. Witnessing violence between parents in childhood was associated with women's physical and sexual, and men's sexual IPV experience; and with women perpetrating emotional, and men perpetrating sexual IPV. Less equitable gender attitudes were associated with men's perpetration of physical IPV. More equitable gender knowledge was associated with women's experience of sexual IPV, and with men perpetrating IPV. Perceived skills to challenge gender inequitable practices were negatively associated with men perpetrating sexual IPV. In conclusion, we found IPV experience and perpetration were highly correlated, and that, contrary to commonly reported gender gaps, men and women experienced similar rates of IPV. We make suggestions for future research, including on IPV prevention interventions in areas with such IPV prevalence that would be beneficial for women and men and future generations.
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Machisa MT, Chirwa ED, Mahlangu P, Sikweyiya Y, Nunze N, Dartnall E, Pillay M, Jewkes R. Factors associated with female students' past year experience of sexual violence in South African public higher education settings: A cross-sectional study. PLoS One 2021; 16:e0260886. [PMID: 34855900 PMCID: PMC8639100 DOI: 10.1371/journal.pone.0260886] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 11/18/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Intimate partner sexual violence and non-partner rape experiences are widely reported by female students in South African higher education institutions, as they are globally. However, limited research has focused on investigating vulnerability factors, which is vital for informing interventions. OBJECTIVE To describe the factors and inter-relationships associated with female students' increased vulnerability to past year experience of partner sexual violence and non-partner rape in South African higher education settings. METHODS We interviewed 1293 female students, i.e., 519 students in six Technical Vocational Education and Training (TVET) college campuses and 774 students at three university campuses. Participants were volunteers aged 18-30. The measured vulnerability factors included childhood sexual abuse, other trauma, mental ill-health, risky sexual behaviours, food insecurity, partner violence, and controlling behaviours. We used bivariate analysis, logistic regression, and structural equation modelling methods. RESULTS Twenty percent of participants experienced past-year sexual violence (17% partner sexual violence and 7.5% non-partner rape). Childhood sexual abuse had direct effects on experiencing past year sexual violence and physical, emotional partner violence or controlling behaviours. Risky sexual behaviours mediated the relationships of childhood sexual abuse or harmful alcohol use and past-year sexual violence experience. Mental ill-health mediated the relationships between childhood sexual abuse, other traumatic exposures, food insecurity, physical, emotional partner violence or controlling behaviours, and past-year partner sexual violence or non-partner rape experience. CONCLUSIONS Risky sexual behaviours, gender inequitable relationship dynamics, mental ill-health, and food insecurity are related and amenable vulnerability factors associated with female students' sexual violence experiences. Therefore, addressing these through comprehensive campus interventions, which are implemented when students first enrol in higher education and are most vulnerable to sexual violence, is critical. Society-wide sexual violence prevention is also imperative.
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Affiliation(s)
- Mercilene T. Machisa
- South African Medical Research Council Gender and Health Research Unit, Pretoria, South Africa
- School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Esnat D. Chirwa
- South African Medical Research Council Gender and Health Research Unit, Pretoria, South Africa
- School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Pinky Mahlangu
- South African Medical Research Council Gender and Health Research Unit, Pretoria, South Africa
- School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Yandisa Sikweyiya
- South African Medical Research Council Gender and Health Research Unit, Pretoria, South Africa
- School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Ncediswa Nunze
- South African Medical Research Council Gender and Health Research Unit, Pretoria, South Africa
| | | | - Managa Pillay
- Department of Basic Education, Pretoria, South Africa
| | - Rachel Jewkes
- South African Medical Research Council Gender and Health Research Unit, Pretoria, South Africa
- School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
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9
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Laslett AM, Graham K, Wilson IM, Kuntsche S, Fulu E, Jewkes R, Taft A. Does drinking modify the relationship between men's gender-inequitable attitudes and their perpetration of intimate partner violence? A meta-analysis of surveys of men from seven countries in the Asia Pacific region. Addiction 2021; 116:3320-3332. [PMID: 33910266 DOI: 10.1111/add.15485] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 12/09/2020] [Accepted: 03/03/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND AIMS Although men's alcohol misuse and less gender-equitable attitudes have been identified as risks for perpetration of intimate partner violence (IPV), less is known about how men's gender-equitable attitudes and drinking act together to increase risk of IPV. This study aimed to assess the independent relationships of lower gender-equitable attitudes and drinking to perpetration of IPV and their interaction among men in seven countries. DESIGN Secondary analysis of the United Nations Multi-Country Study on Men and Violence (UNMCS) and Nabilan Study databases consisting of (1) unadjusted and adjusted logistic regression to measure the association of perpetration of IPV with gender-equitable men (GEM) scale score and regular heavy episodic drinking (RHED) and (2) meta-analyses of prevalence and effect estimates adjusted for country-level sites and countries. SETTING AND PARTICIPANTS A total of 9148 ever-partnered 18-49-year-old men surveyed in 2011-15 from 18 sites in Bangladesh, Cambodia, China, Indonesia, Papua New Guinea, Sri Lanka and Timor Leste. MEASUREMENTS The outcome variable is reported perpetration of physical or sexual IPV in the previous year. INDEPENDENT VARIABLES GEM scale scores; RHED, defined as six or more drinks in one session at least monthly (compared with other drinkers and abstainers). FINDINGS Pooled past-year prevalence of perpetration of IPV was 13% [95% confidence interval (CI) = 9-16%]. GEM scores and RHED were independently associated with perpetration of IPV overall and in most sites. Pooled odds ratios (ORs) for perpetration of IPV with less equitable GEM scores were 1.07 (95% CI = 1.04, 1.09) and with RHED were 3.42 (95% CI = 2.43, 4.81). A significant interaction between GEM score and RHED (P = 0.001) indicated that RHED increased the relationship of less gender-equitable attitudes and perpetration of IPV. CONCLUSION Both gender-inequitable attitudes and drinking appear to be associated with perpetration of intimate partner violence by men, with regular heavy episodic drinking increasing the likelihood of intimate partner violence among men with less equitable gender attitudes.
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Affiliation(s)
- Anne-Marie Laslett
- Centre for Alcohol Policy Research, School of Psychology and Public Health, La Trobe University, Melbourne, Australia.,National Drug Research Institute, Curtin University, Perth, Australia.,Melbourne School of Global and Population Health, University of Melbourne, Melbourne, Australia
| | - Kathryn Graham
- National Drug Research Institute, Curtin University, Perth, Australia.,Centre for Addiction and Mental Health, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Ingrid M Wilson
- Singapore Institute of Technology, Singapore.,Judith Lumley Centre, La Trobe University, Melbourne, Australia.,Department of Sociology, Social Policy and Criminology, University of Liverpool in Singapore, Singapore
| | - Sandra Kuntsche
- Centre for Alcohol Policy Research, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Emma Fulu
- The Equality Institute, Melbourne, Australia
| | - Rachel Jewkes
- Office of the Executive Scientist, South African Medical Research Council, Tygerberg, South Africa
| | - Angela Taft
- Judith Lumley Centre, La Trobe University, Melbourne, Australia
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10
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Fine SL, Kane JC, Murray SM, Skavenski S, Munthali S, Mwenge M, Paul R, Mayeya J, Murray LK. The Role of Violence Acceptance and Inequitable Gender Norms in Intimate Partner Violence Severity Among Couples in Zambia. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:NP10744-NP10765. [PMID: 31542985 PMCID: PMC9808822 DOI: 10.1177/0886260519876722] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Inequitable gender norms, including the acceptance of violence in intimate relationships, have been found to be associated with the occurrence of intimate partner violence (IPV) perpetration and victimization. Despite these findings, few studies have considered whether inequitable gender norms are related to IPV severity. This study uses baseline data from a psychotherapeutic intervention targeting heterosexual couples (n = 247) in Lusaka, Zambia, who reported moderate to severe male-perpetrated IPV and male hazardous alcohol use to consider: (a) prevailing gender norms, including those related to IPV; (b) the relationship between IPV acceptance and IPV severity; and (c) the relationship between inequitable gender norms and IPV severity. Multiple linear regression analyses were used to model the relationships between IPV acceptance and inequitable gender norms, and female-reported IPV severity (including threats of violence, physical violence, sexual violence, and total violence), separately among male and female participants. In general, men and women were similar in their patterns of agreement with gender norms, with both highly endorsing items related to household roles. More than three-quarters of men (78.1%) and women (78.5%) indicated overall acceptance of violence in intimate relationships, with no significant differences between men and women in their endorsement of any IPV-related gender norms. Among men, IPV acceptance was associated with a statistically significant increase in IPV perpetration severity in terms of threatening violence (B = 5.86, 95% confidence interval [CI] = [1.84, 9.89]), physical violence (B = 4.54, 95% CI = [0.10, 8.98]), and total violence (B = 11.65, 95% CI = [3.14, 20.16]). There was no association between IPV acceptance and IPV victimization severity among women. Unlike IPV acceptance, there was no evidence for a relationship between inequitable gender norms and IPV severity for either men or women. These findings have implications for the appropriateness of gender transformative interventions in targeting men and women in relationships in which there is ongoing IPV.
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Affiliation(s)
| | - Jeremy C. Kane
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sarah M. Murray
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Saphira Munthali
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Mwamba Mwenge
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Ravi Paul
- University of Zambia School of Medicine, Lusaka, Zambia
| | | | - Laura K. Murray
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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11
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Kidman R, Waidler J, Palermo T. Uptake of HIV testing among adolescents and associated adolescent-friendly services. BMC Health Serv Res 2020; 20:881. [PMID: 32943066 PMCID: PMC7499858 DOI: 10.1186/s12913-020-05731-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 09/10/2020] [Indexed: 11/16/2022] Open
Abstract
Background HIV testing remains low among adolescents. Making public health services more adolescent-friendly is one strategy used to encourage testing. However, it remains unclear whether government-led initiatives have a meaningfully impact. Methods The current study is observational and utilizes two sources of data (health-facility and adolescent-level) from one round of data collection of an on-going, longitudinal impact evaluation of a pilot cash plus program targeting adolescents. This study linked data from adolescent surveys (n = 2191) to data collected from nearby government-run health facilities (n = 91) in two rural regions of Tanzania. We used log binomial regression models to estimate the association between specific adolescent-friendly health service (AFHS) characteristics and adolescents’ uptake of 1) HIV testing and 2) visiting a health care facility in the past year for sexual and reproductive health (SRH) services. Results Most adolescents (67%) lived in a village with a health facility, and all offered HIV services. We find, however, that AFHS have not been fully implemented. For example, less than 40% of facilities reported that they had guidelines for adolescent care. Only 12% of facilities had a system in place for referral and follow-up with adolescent clients, yet this was an important predictor of both past-year HIV testing (RR = 1.28, p < 0.1) and SRH visits (RR = 1.44, p < 0.05). Less than half (44%) offered services for survivors of gender-based violence (GBV), a significant predictor of past-year HIV testing (RR = 1.20, p < 0.05) and SRH visits (RR = 1.41, p < 0.01) among sexually-active adolescents. Conclusions We find that national guidelines on AFHS have not been fully translated into practice at the local level. We highlight particular gaps in adolescent referral systems and GBV services. Scaling up these two essential services could encourage greater HIV testing among a high-risk population, in addition to providing much needed support for survivors of violence.
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Affiliation(s)
- Rachel Kidman
- Department of Family, Population and Preventive Medicine, HSC Level 3, Room 79 Stony Brook University (State University of New York), Stony Brook, NY, 11794, USA
| | - Jennifer Waidler
- UNICEF Office of Research - Innocenti, Via degli Alfani 58, 50121, Florence, Italy.
| | - Tia Palermo
- Department of Epidemiology at Environmental Health, 270 Farber Hall, University at Buffalo (State University of New York), Buffalo, NY, 14214-8001, USA
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Abramsky T, Kapinga I, Mshana G, Lees S, Hansen CH, Hashim R, Stöckl H, Kapiga S, Harvey S. Couples data from north-western Tanzania: Insights from a survey of male partners of women enrolled in the MAISHA cluster randomized trial of an intimate partner violence prevention intervention. PLoS One 2020; 15:e0240112. [PMID: 33006997 PMCID: PMC7531846 DOI: 10.1371/journal.pone.0240112] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 09/18/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Globally, around 30% of ever-partnered women have experienced physical and/or sexual intimate partner violence (IPV) during their lifetime. To date, most research into causes and prevention of IPV involves surveys of women, with little research into risk-factors for male perpetration. This paper describes a survey of male partners of women participating in the MAISHA cluster randomised trial (CRT) of an IPV prevention intervention, in Mwanza City, Tanzania. Using linked couples' data, we explore man-, woman-, and relationship-/household-level factors associated with physical and sexual IPV. METHODS Women were interviewed at baseline and 29-months follow-up. At follow-up, women were asked for consent to invite their partner to participate in the male survey. We describe response rates for the women's follow-up and male partners' surveys, and identify factors associated with women's consent to approach partners. Multivariate logistic regression was used to explore factors associated with women's past-year experiences of physical and sexual IPV. RESULTS 512 (65%) partnered women consented for the partner to be approached, higher among intervention than control women. 425 (83%) male partners were interviewed. Women consenting were disproportionately likely to be in longer-term relationships. Past-year IPV was associated with lower consent among control women, but greater consent in the intervention arm. Factors associated with increased odds of physical IPV were women's childhood experiences of abuse, young age, women's lower income and women's attitudes justifying IPV. Sexual IPV was associated with women's childhood experiences of abuse, young age, educational disparity within couple, men's alcohol use and women's poor mental health. CONCLUSIONS We successfully conducted a survey of male partners with the full consent of women trial participants. The breadth of factors associated with IPV demonstrates the need for IPV prevention interventions to work with women and men, and specifically couples. Interventions should address risk-factors for both physical and sexual IPV.
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Affiliation(s)
- Tanya Abramsky
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
- * E-mail:
| | - Imma Kapinga
- Mwanza Intervention Trials Unit, Mwanza, Tanzania
| | - Gerry Mshana
- Mwanza Intervention Trials Unit, Mwanza, Tanzania
- National Institute for Medical Research, Mwanza, Tanzania
| | - Shelley Lees
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Christian Holm Hansen
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Heidi Stöckl
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Saidi Kapiga
- Mwanza Intervention Trials Unit, Mwanza, Tanzania
- Department of Infectious Diseases Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sheila Harvey
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Mwanza Intervention Trials Unit, Mwanza, Tanzania
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Halim N, Steven Mzilangwe E, Reich N, Badi L, Simmons E, Servidone M, Bingham Holmes N, Kawemama P, Messersmith LJ. Together to end violence against women in Tanzania: Results of a pilot cluster randomized controlled trial to evaluate preliminary effectiveness of interpersonal and community level interventions to address intimate partner violence. Glob Public Health 2019; 14:1653-1668. [PMID: 31084264 DOI: 10.1080/17441692.2019.1609062] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
In Tanzania, women suffer high rates of intimate partner violence (IPV). We conducted a pilot cluster randomised controlled trial to test the feasibility, acceptability and preliminary effectiveness of IPV prevention interventions targeting men and communities in nine villages randomly assigned to one of three study arms (n = 450 couples). In the Control Group, women participated in savings groups while male partners received no intervention. In Intervention Group 1, women participated in savings groups and men participated in peer-groups addressing gender relations and IPV prevention. In Intervention Group 2, women participated in savings groups, men participated in peer-groups, and community leaders facilitated dialogues on similar topics. Recruitment was completed within one month with 95% retained in the intervention and 81% retained in the endline survey. Acceptability was high, with men participating in 82% of peer-group session hours. More men in Interventions 1 (24%) and 2 (19%) disagreed with wife-beating compared to men in the Control (13%); and more men reported non-perpetration of IPV in Interventions 1 (16%) and 2 (14%) compared to the Control (-2%). Findings suggest a fully powered RCT may detect significant reductions in men's justification and use of IPV, paving the way for evidence-based violence prevention programming. Trial registration: This study is registered with ClinicalTrials.gov. Identifier: NCT02434796.
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Affiliation(s)
- Nafisa Halim
- Boston University School of Public Health , Boston , MA , USA
| | | | - Naomi Reich
- World Education Inc./Bantwana (WEI/Bantwana) , Boston , MA , USA
| | - Lilian Badi
- World Education Inc./Bantwana (WEI/Bantwana) , Arusha , Tanzania
| | | | - Maria Servidone
- Boston University School of Public Health , Boston , MA , USA
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14
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Simmons E, Halim N, Servidone M, Steven E, Reich N, Badi L, Holmes N, Kawemama P, Messersmith LJ. Prevention and Mitigation of Intimate-Partner Violence: The Role of Community Leaders in Tanzania. Violence Against Women 2019; 26:359-378. [PMID: 30898055 DOI: 10.1177/1077801219832923] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Intimate-partner violence (IPV) is a major public health issue that disproportionately affects women, especially in Tanzania where 40% of women report experiencing IPV. While IPV research has focused on IPV victims and perpetrators, community leaders can provide valuable insight on IPV at the community level. We conducted 50 key informant interviews with community leaders in nine villages in the Karatu district. These leaders identified common themes regarding IPV causes and consequences, reporting methods, and future recommendations. This information can help mitigate IPV at the community level in future interventions and shows community leaders themselves could be powerful tools in future IPV programming.
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Affiliation(s)
| | - Nafisa Halim
- Boston University School of Public Health, MA, USA
| | | | | | - Naomi Reich
- World Education Inc./Bantwana, Boston, MA, USA
| | - Lilian Badi
- World Education Inc./Bantwana, Arusha, Tanzania
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15
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Wirtz AL, Perrin NA, Desgroppes A, Phipps V, Abdi AA, Ross B, Kaburu F, Kajue I, Kutto E, Taniguchi E, Glass N. Lifetime prevalence, correlates and health consequences of gender-based violence victimisation and perpetration among men and women in Somalia. BMJ Glob Health 2018; 3:e000773. [PMID: 30105094 PMCID: PMC6074632 DOI: 10.1136/bmjgh-2018-000773] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 05/14/2018] [Accepted: 05/17/2018] [Indexed: 11/07/2022] Open
Abstract
Background Humanitarian emergencies increase the risk of gender-based violence (GBV). We estimated the prevalence of GBV victimisation and perpetration among women and men in urban settings across Somalia, which has faced decades of war and natural disasters that have resulted in massive population displacements. Methods A population-based survey was conducted in 14 urban areas across Somalia between December 2014 and November 2015. Results A total of 2376 women and 2257 men participated in the survey. One in five men (22.2%, 95% CI 20.5 to 23.9) and one in seven (15.5%; 95% CI 14.1 to 17.0) women reported physical or sexual violence victimisation during childhood. Among women, 35.6% (95% CI 33.4 to 37.9) reported adult lifetime experiences of physical or sexual intimate partner violence (IPV) and 16.5% (95% CI 15.1 to 18.1) reported adult lifetime experience of physical or sexual non-partner violence (NPV). Almost one-third of men (31.2%; 95% CI 29.4 to 33.1) reported victimisation as an adult, the majority of which was physical violence. Twenty-two per cent (21.7%; 95% CI 19.5 to 24.1) of men reported lifetime sexual or physical IPV perpetration and 8.1% (95% CI 7.1 to 9.3) reported lifetime sexual or physical NPV perpetration. Minority clan membership, displacement, exposure to parental violence and violence during childhood were common correlates of IPV and NPV victimisation and perpetration among women and men. Victimisation and perpetration were also strongly associated with recent depression and experiences of miscarriage or stillbirth. Conclusion GBV is prevalent and spans all regions of Somalia. Programmes that support nurturing environments for children and provide health and psychosocial support for women and men are critical to prevent and respond to GBV.
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Affiliation(s)
- Andrea L Wirtz
- Department of Epidemiology, Center for Public Health and Human Rights, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Nancy A Perrin
- Community Public Health Nursing, Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
| | | | - Verena Phipps
- The World Bank, Washington, District of Columbia, USA
| | - Ali A Abdi
- Community Public Health Nursing, Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
| | - Brendan Ross
- United Nations Children's Emergency Fund (Unicef), Mogadishu, Somalia
| | - Francesco Kaburu
- Comitato Internazionale per lo Sviluppo dei Popoli, Nairobi, Kenya
| | - Isatu Kajue
- United Nations Population Fund (UNFPA), New York City, New York, USA
| | - Ezekiel Kutto
- United Nations Population Fund (UNFPA), New York City, New York, USA
| | - Eri Taniguchi
- United Nations Population Fund (UNFPA), New York City, New York, USA
| | - Nancy Glass
- Community Public Health Nursing, Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
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16
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Halim N, Steven E, Reich N, Badi L, Messersmith L. Variability and validity of intimate partner violence reporting by couples in Tanzania. PLoS One 2018; 13:e0193253. [PMID: 29518162 PMCID: PMC5843259 DOI: 10.1371/journal.pone.0193253] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 02/07/2018] [Indexed: 11/23/2022] Open
Abstract
In recent years, major global institutions have amplified their efforts to address intimate partner violence (IPV) against women-a global health and human rights violation affecting 15-71% of reproductive aged women over their lifetimes. Still, some scholars remain concerned about the validity of instruments used for IPV assessment in population-based studies. In this paper, we conducted two validation analyses using novel data from 450 women-men dyads across nine villages in Northern Tanzania. First, we examined the level of inter-partner agreement in reporting of men's physical, sexual, emotional and economic IPV against women in the last three and twelve months prior to the survey, ever in the relationship, and during pregnancy. Second, we conducted a convergent validity analysis to compare the relative efficacy of men's self-reports of perpetration and women's of victimization as a valid indicator of IPV against Tanzanian women using logistic regression models with village-level clustered errors. We found that, for every violence type across the recall periods of the last three months, the last twelve months and ever in the relationship, at least one in three couples disagreed about IPV occurrences in the relationship. Couples' agreement about physical, sexual and economic IPV during pregnancy was high with 86-93% of couples reporting concordantly. Also, men's self-reported perpetration had statistically significant associations with at least as many validated risk factors as had women's self-reported victimization. This finding suggests that men's self-reports are at least as valid as women's as an indicator of IPV against women in Northern Tanzania. We recommend more validation studies are conducted in low-income countries, and that data on relationship factors affecting IPV reports and reporting are made available along with data on IPV occurrences.
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Affiliation(s)
- Nafisa Halim
- Department of Global Health, Boston University School of Public Health, Boston, MA, United States of America
| | - Ester Steven
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Naomi Reich
- World Education Inc./Bantwana Initiative, Boston, MA, United States of America
| | - Lilian Badi
- World Education, Inc./Bantwana Initiative–Tanzania, Arusha, Tanzania
| | - Lisa Messersmith
- Department of Global Health, Boston University School of Public Health, Boston, MA, United States of America
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